Antibiotic Prophylaxis in Clean-Contaminated Head and Neck Oncologic Surgery

Abstract

The use of antibiotic prophylaxis in head and neck oncologic surgery has greatly reduced the risk of postoperative wound infection and the corresponding increase in morbidity and health care costs. Conversely, inappropriate perioperative use of antibiotics increases costs and risks to patients. Antibiotic prophylaxis is beneficial only in clean-contaminated head and neck surgery; targets are the bacterial flora that commonly inhabit the skin and upper aerodigestive tract, with antibiotics effective against gram-positive aerobic organisms and anaerobic organisms providing the best coverage. Maximum efficacy is achieved with immediate preoperative and short-term (< 48 hours) postoperative antimicrobial administration in adequate doses. Optimum benefit from prophylaxis in head and neck oncologic surgery depends on appropriate selection and administration of antibiotics in combination with sound, established surgical principles.

Comparative study of two cefazolin prophylactic protocols in oncologic surgery of the larynx: A randomized trial

“…This stems primarily from the gross and often extensive and prolonged contamination of the neck wound with oropharyngeal secretions. But the use reduce the postoperative wound infection and decrease it to the range of about 14-40% [2,5]. However, even the best surgical techniques and most widespread antibiotics have not completely eradicated this problem [12,13].…”

“…According to the bar chart, none of the patients in either group had wound infection difference between two groups in wound infection rate with in weight, age, operation length, and hospitalization time. head and neck surgery should cover gram-positive and anaerobic bacteria, and the application of antibiotics beyond 48 hours after the operation time is not necessary [2,3]. The need for gram negative coverage is still under debate [3,17].…”

“…A sample size of 90 patients (45 patients in each group) was calculated to detect a difference of 80% (p1) in short course antibiotic group and 40% (p2) in longer antibiotic group [2,3,5,9] for an alpha error of 5% and a beta error 10%.…”

“…Patients diagnosed with morbidity and present a high anesthetic and surgical risk. The development of wound infection in patients undergoing laryngeal cancer surgery can have devastating effects such as wound breakdown, the development of mucocutaneous hospital stay and costs, and may delay the administration of radiotherapy following surgery, which will increase the risk of tumor recurrence [2].…”

“…The use of prophylactic antibiotics in head and neck surgery has been well reviewed and accepted in the surgical articles [2,8]. Prospective, randomized, trials have uniformly accepted that perioperative antibiotic prophylaxis has a key role in patients undergoing cleancontaminated or contaminated head and neck surgery, because without receiving antibiotics, the infection rate approaches 80-100% [3,9] in the wound infection rate to <10% by using appropriate perioperative antibiotic regimes [2,8]. Controversy, however, exists over the length and type of antibiotics [10,11].…”